Conflict of interest
Post-infectious irritable bowel syndrome: The past, the present and the future
Article first published online: 28 MAR 2011
© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Special Issue: Proceedings of the first Asian Pacific Topic Conference (APTC2010) on Functional Gastrointestinal Disorders Organized by the Japanese Society of Gastroenterology (JSGE)and Asian Pacific Association of Gastroenterology (APAGE), Tokyo, Japan, 26-27 November 2010
Volume 26, Issue Supplement s3, pages 94–101, April 2011
How to Cite
Ghoshal, U. C. and Ranjan, P. (2011), Post-infectious irritable bowel syndrome: The past, the present and the future. Journal of Gastroenterology and Hepatology, 26: 94–101. doi: 10.1111/j.1440-1746.2011.06643.x
No potential conflict of interest to disclose.
- Issue published online: 28 MAR 2011
- Article first published online: 28 MAR 2011
- Accepted for publication 24 January 2011.
- chronic diarrhea;
- functional bowel disease;
- tropical sprue
Background: Irritable bowel syndrome (IBS), once thought to be a psychosomatic disease, is being considered to be more organic. Post-infectious IBS (PI-IBS), defined as acute onset IBS (by Rome criteria) after gastrointestinal infection in an individual without prior IBS with two or more of the followings: fever, vomiting, diarrhea, a positive stool culture. The recent and old literature of PI-IBS will be reviewed. Future directions for research will be presented.
Methods: Literature on PI-IBS was reviewed by electronic search and cross references of these papers.
Results: Interest in studies on PI-IBS, which was described five to six decades ago, re-surfaced recently. 3.6 to 32% patients with acute gastroenteritis develop PI-IBS during 3–12 month follow-up. PI-IBS is commonly diarrhea predominant. Factors implicated in development include nature of pathogens, duration and severity of diarrhea, younger age, female gender and psychological co-morbidities like anxiety and depression. The pathogenesis of PI-IBS is largely related to continuing gut inflammation due to inability of the host to contain the inflammatory reaction, altered gut microbiota, increased intestinal permeability, muscle hyper-contractility and visceral hypersensitivity. There could be an overlap between PI-IBS and post-infectious malabsorption syndrome (PI-MAS), popularly known as tropical sprue.
Conclusions: Development of IBS in a subset of patients with acute gastroenteritis is uncontested. This is expected to open a paradigm shift in understanding the pathogenesis of IBS. Future studies should address the issue of overlap of PI-IBS and PI-MAS. Exploring the molecular mechanisms of pathogenesis of PI-IBS may help to design preventive and therapeutic strategies.